The purpose of this integrative literature review was to provide a compilation and review of literature related to perinatal outcomes of clients with antepartum or intrapartum oligohydramnios and management decisions applied to these clients. This paper is intended to synthesize and summarize the most current knowledge retrieved in these topics between the years of 1990- 2000. A general search using key terms was conducted, and yielded 63 prospective articles comprised of full articles, abstracts, and literature reviews. Seventeen articles on oligohydramnios, amniotic fluid volume measurements, and perinatal outcomes were retained out of the 35 that were found. The search for the literature discussing management of oligohydramnios produced 9 articles, of which 3 were found to be pertinent to this project. Twelve of the total 39 articles retained were literature reviews and were used for citation and identification of additional information material to this topic. Seven of the 39 articles were retained for the sole purpose of enabling the author to provide a descriptive, thorough review on the relevant concepts of this review. Studies reviewing amniotic fluid volume/oligohydramnios and perinatal outcomes suggest great variance among likelihood of adverse perinatal outcomes. Studies reviewing management of oligohydramnios suggest amnioinfusion may have obstetrical and perinatal benefits for the client with oligohydramnios. Aggressive management including indication for cesarean section related to fetal distress and labor induction were implied with minimal discussion on conservative management for these clients.

Indiana University-Purdue University Indianapolis (IUPUI) / Objectives: To determine (1) whether prescribed and delivered energy and protein intakes during the first two weeks of life met Ziegler’s estimated requirements for Very Low Birth Weight (VLBW) infants, (2) if actual energy during the first week of life correlated with time to regain birth weight and reach full enteral nutrition (EN) defined as 100 kcal/kg/day, (3) if growth velocity from time to reach full EN to 36 weeks’ postmenstrual age (PMA) met Ziegler’s estimated fetal growth velocity (16 g/kg/day), and (4) growth outcomes at 36 weeks’ PMA. Study design: Observational study of feeding, early nutrition and early growth of 40 VLBW infants ≤ 30 weeks GA at birth in three newborn intensive care units NICUs. Results: During the first week of life, the percentages of prescribed and delivered energy (69% [65 kcal/kg/day]) and protein (89% [3.1 g/kg/day]) were significantly less than theoretical estimated requirements. Delivered intakes were 15% less than prescribed because of numerous interruptions in delivery and medical complications. During the second week, the delivered intakes of energy (90% [86 kcal/kg/day]) and protein (102% [3.5 g/kg/day]) improved although the differences between prescribed and delivered were consistently 15%. Energy but not protein intake during the first week was significantly related to time to reach full EN. Neither energy nor protein intake significantly correlated with days to return to birth weight. The average growth velocity from the age that full EN was attained to 36 weeks’ PMA (15 g/kg/day) was significantly less than the theoretical estimated fetal growth velocity (16 g/kg/day) (p<0.03). A difference of 1 g/kg/day represents a total deficit of 42 - 54 grams over the course of a month. At 36 weeks’ PMA, 53% of the VLBW infants had extrauterine growth restriction, or EUGR (<10th percentile) on the Fenton growth grid and 34% had EUGR on the Lubchenco growth grid. Conclusions: The delivered nutrient intakes were consistently less than 15% of the prescribed intakes. Growth velocity between the age when full EN was achieved and 36 weeks’ PMA was 6.7% lower than Ziegler’s estimate. One-third to one-half of the infants have EUGR at 36 weeks’ PMA.

Neutrophil activation is the most important initial immune defense against invading microbes in newborn infants. The reduced neutrophil migration and uncontrolled regulation of reactive oxygen species (ROS) production observed in neonates, could result in a diminished infectious response or in tissue damage. The aims were to study neutrophil chemotactic response towards IL-8 and fMLP in term neonates; to examine neutrophil receptor expression involved in adhesion, migration, phagocytosis and complement after stimulation with IL-8 and fMLP in term neonates; and to investigate neutrophil production of ROS, induced by PMA and E.coli, after preincubation with IL-8 and fMLP in term and preterm newborn infants. Comparisons were made to neutrophils from healthy adults. Chemotaxis was distinguished from randomly migrating neutrophils, and the neutrophil migration distance and the number of migrating neutrophils per distance was evaluated. Neutrophils were labeled with antibodies to cell surface antigens (CD11b, CD18, CD65, CD15S, CD162, CD44, CD35, CD88, CD181, CD182 and CD64) after stimulation with IL-8 and fMLP. After preincubation of neutrophils with fMLP or IL-8 and stimulation with PMA or E.coli, respiratory burst was detected. The same analyses were also made in preterm infants (median 25+3weeks GA; range 23+0–29+2) within 3 days postnatal age. Neutrophils from neonates exhibited different migratory and receptor responses to IL-8 and fMLP, with a diminished response towards IL-8 in term newborn infants in terms of reduced chemotaxis and modulation of receptors involved in adhesion, chemotaxis, complement and phagocytosis as compared to adults. fMLP reduced PMA- and E.coli-induced respiratory burst in neutrophils from term neonates and adults. The reduced respiratory burst by fMLP may be a mechanism for reducing the detrimental effects of uncontrolled inflammation. Although a similar burst reduction was observed in preterm infants born &gt;25 weeks GA with fMLP, a diminished neutrophil respiratory burst modulation in very preterm infants cannot be excluded and requires further studies at different gestational and postnatal ages.

This project encompasses program evaluations of infant massage intervention and its impact in the overall development of infants and children born with disabilities or babies born at risk for developmental delays.

Dissertation submitted in fulfilment of the requirements for the Degree of Master of Technology: Emergency Medical Care, Durban University of Technology, 2012. / Introduction The safe transfer of neonates from one healthcare facility to another is an integral component in the process of neonatal care. Neonates, a term applying specifically to infants during the first 28 days of life, are transferred from medical healthcare facilities which do not have specialist care or intensive care management to more specialised facilities in order to improve their clinical outcome and chance of survival. The transfer system is thus an important aspect of the overall care provided to neonates. The transfer process, however, poses a threat of aggravating the clinical condition of the neonate. Inter-healthcare facility transfer of a neonate requires careful planning, skilled personnel and specialised equipment to maintain the continuum of care, as this directly impacts on the morbidity and mortality of the neonate. Purpose of the study The purpose of the study was to undertake a descriptive analysis of the current neonatal inter-healthcare facility transfer system in the eThekwini Health District of KwaZulu-Natal (KZN). This service is provided by the public sector ambulance service known as the Emergency Medical Rescue Service (EMRS). The study, based on 120 consecutive transfers, assessed the clinical demographics of the neonates, the time taken to complete the transfers, including time sub-intervals, the equipment that was necessary for the transfers and the qualifications and procedures performed by the transfer team. The study also identified any adverse events that were encountered during the transfers. Methodology The study was conducted from 19 December 2011 to 30 January 2012. It used quantitative methodology and a non-experimental prospective design to undertake a descriptive analysis of 120 inter-healthcare facility transfers of neonates within the eThekwini Health District of KwaZulu-Natal. Data collection relied upon two types of questionnaires. A descriptive survey method incorporated logistic and deductive reasoning to evaluate the objectives of this study. Frequency distributions were generated to describe data categories. Bivariate analysis was conducted using chi- square. Results During the study period there were a total of 120 neonatal inter-healthcare facility transfers. All referrals were undertaken by road ambulances. Eighty-three (62.2%), transfers were undertaken by the operational ambulance units, 35 (29.2%) by the obstetric unit and 2 (1.7%) by the planned patient transport units. Thirty one (28.5%) transfers were on Fridays, followed by 24 (20.8%) on Mondays and 20 (16.6%) on weekends. Ninety seven (80.8%) were during the hours of dayshift (07h00-19h00) and 23 (19.2%) were during nightshift (19h00-07h00). Of the 120 neonatal transfers, 29 (24.2%) were specialised transfers, of which 22 (75.9%) were ventilated. With reference to the gestational ages of the neonates being transferred 90 (76.7%), were pre-term, 26 (21.7%) were term and 2 (1.7%) were post-term. There were 11 (9.2%) newborns (from birth to 4 hours), 56 (46.7%) early neonates (from 4 hours to 7 days) and 53 (44.2%) late neonates (from 7 days to 28 days). Of the 120 neonatal transfers, 90 (75.0%) were pre-term having associated co-morbidities and 49 (40.8%) had respiratory problems. The mean time ± standard deviation (SD), taken by EMRS eThekwini to complete an inter-healthcare facility transfer was 3h 49min ± 1h 57min. The minimum time to complete a transfer was 55min and the maximum time was 10h 34min. The mean time ± SD from requests to dispatch was 1h 20min ± 1h 36min. The delays in dispatch were associated with no ambulances being available 70 (58.3%), no ALS personnel available 48 (40.0%), no equipment available 23 (19.2%) and no ILS personnel available 7 (5.8%) to undertake the transfers. Junior or inexperienced personnel in the communication centre also contributed to the time delays by dispatching ALS personnel for non-specialised transfers and requesting neonatal equipment when it had not been requested by the referring personnel for the transfer. The mean time ± SD from the referring hospital to the time mobile to the receiving hospital was 43min ± 26min. Six (5.0%) neonates were clinically unstable at the referring facility for transfer. For 15 (12.5%) transfers, neonates had been inappropriately packaged for transport by the hospital staff, which added to the delays, p. value = 0.018. The necessary equipment was unavailable for 37 (30.8%) of the transfers. The lack of equipment was due to problems such as poor resource allocation, and malfunctioning, inappropriate, insufficient and unsterile equipment. The pre- departure checklist had not been completed in 50 (41.67%) of the transfers. The study identified 10 (8.3%) adverse events related to the physiological state of the neonate and included 1 (0.8%) mortality. Nine (7.5%) neonates suffered serious life threating complications during transportation, 8 (6.7%) of which were due to desaturation, 6 (5.0%) due to respiratory deterioration, 3 (2.5%) due to cardiac deterioration and 1 (0.8%) due to temperature related problems. Eighteen (15.0%) of 120 transfers experienced equipment related adverse events of which 9 (7.5%) were associated with ventilators, 9 (7.5%) with incubators, 3 (2.5%) with the ambulance, 2 (1.7%) with the oxygen supply and 1 (0.8%) with arterial cannulation. Five (33.3%) of the 15 equipment related adverse events contributed directly to life threatening physiologically related adverse events, p. value = 0.007. Conclusion and recommendation The Emergency Medical Rescue Service (EMRS) is involved in the transportation of a significant number of neonates between various healthcare facilities in the eThekwini Health District, some requiring intensive care and some not. This descriptive, prospective study has identified numerous shortfalls in the service provided by the EMRS in the eThekwini District. Inter-healthcare facility transfer of neonates can be safely performed by the transport services if the operations are well co-ordinated and there are dedicated, specialised and trained transport teams armed with appropriate equipment and medication, together with the guidance of policies and quality assurance. Transport teams must be trained to provide this specialised care in various environments, including ground and air ambulances and understand the multiphase neonatal transfer processes. There must be good communication and co-ordination by all role players, which is underpinned by good team work to improve the standards of neonatal care and monitoring. Only then can clinical excellence be achieved when transporting neonates between healthcare facilities.

Thesis (MEng) -- Stellenbosch University, 2014. / ENGLISH ABSTRACT: The thermal regulation response of a neonate has to maintain temperature homeostasis, thus resisting the changes to core temperature caused by the unstable external environment. In this thesis a theoretical thermal regulation response model for human infants subject to a well-defined environment is presented. This model will aid in understanding the influences of environmental effects on core and skin temperature. The respiratory system was also included in the thermal regulation response model. A literature study was undertaken emphasising thermal regulation of neonates. The blood circulation system, skin tissue physiology and the respiratory system physiology were reviewed and helped to provide a better understanding of the thermal regulation mechanisms and how heat transfer theory can be used to analyse heat loss in neonates. The thermal heat transfer properties of skin tissue was specified and used in the development of the theoretical simulation model. The bioheat equation developed by Pennes was reviewed as well as a mathematical model developed by Fiala et al. The theoretical model was developed by applying the conservation of energy and the applicable properties to one dimensional layers to generate a set of time dependent differential equations. The set of equations was solved using an explicit numerical finite difference method, given the initial conditions. The mathematical model included heat loss through the skin, heat loss through the respiratory system, as well as the effect of environments (in incubator or in a bassinette) with different temperatures, relative humidity’s and air velocities. Clothing was also incorporated. A clinical trial was conducted to facilitate a better understanding of thermal stability in neonates. The data acquired during the clinical trial was also used to verify/validate the theoretical simulation model. The results from the simulation temperatures were compared with the average outer skin layer temperature measured during the clinical trial and an average deviation of only 0.22 °C was found, thereby proving that the simulation model gives realistic results. An experimental respiratory model was designed to simulate the respiratory system and illustrate the functioning thereof with regards to heat transfer. This was done by designing an experimental mechanical lung apparatus. The apparatus was tested and successfully imitated the respiratory system with regards to heat transfer. The results obtained from this experiment indicated that the trachea must be moistened continuously in order to condition inhaled air. The outcome of this project identified two possible applications. For the first application it can be used as a test tool for quickly evaluating the influence of different environmental conditions in the transient temperature distribution of neonates. The second application would be to enable medical professionals to monitor the influence of the thermal environment, including the temperature, relative humidity and air velocity, on the neonate’s temperature change to allow for a speedier thermal intervention strategy. / AFRIKKANSE OPSOMMING: Die hitte regulering reaksie van 'n pasgebore baba moet temperatuur homeostase handhaaf, en sodoende die veranderinge aan die kern temperatuur weerstaan wat veroorsaak word deur ‘n onstabiele eksterne omgewing. In hierdie tesis word 'n teoretiese hitte regulerings reaksie model vir menslike babas, onderhewig aan 'n goed-gedefinieerde omgewing, aangebied. Hierdie model sal help met die verstaan van die invloed wat omgewings effekte het op die kern en vel temperatuur. Die respiratoriese sisteem is ook ingesluit in die hitte regulering reaksie model. 'n Literatuurstudie is onderneem met die klem op hitte regulering van pasgebore babas. Die bloed sirkulasie sisteem, vel weefsel fisiologie en die respiratoriese sisteem fisiologie is hersien en help met beter begrip van die hitte regulering meganismes en hoe hitteoordrag teorie kan gebruik word om hitte verlies in pasgebore babas te analiseer. Die hitte-oordrag eienskappe van vel weefsel is gespesifiseer en word gebruik in die ontwikkeling van die teoretiese simulasie model. Die ‘bioheat’ vergelyking ontwikkel deur Pennes is hersien asook 'n wiskundige model wat ontwikkel is deur Fiala et al. Die teoretiese model is ontwikkel deur die toepassing van die behoud van energie tesame met die gebruik van toepaslike eienskappe en een dimensionele lae om 'n stel tyd afhanklike differensiaalvergelykings op te wek. Die stel vergelykings is opgelos met behulp van 'n eksplisiete numeriese eindige verskil metode, gegewe die aanvanklike toestande. Die wiskundige model sluit in die hitte verlies deur die vel, hitte verlies deur die respiratoriese stelsel, sowel as die effek van die omgewing (broeikas of in 'n bassinette) met verskillende temperature, relatiewe humiditeit en lug snelhede. Klere is ook in ag geneem. 'n Kliniese proef is gedoen om 'n beter begrip van termiese stabiliteit in pasgebore babas te fasiliteer. Die data wat tydens die kliniese proef verhaal is, is ook gebruik om die die teoretiese simulasie model te verifieer. Die resultate van die simulasie temperature is vergelyk met die gemiddelde buitenste vel laag temperatuur gemeet tydens die kliniese proef en 'n gemiddelde afwyking van slegs 0.22 °C is gevind, wat dus bewys dat die simulasie model realistiese resultate gee. 'n Eksperimentele respiratoriese model is ontwerp om die respiratoriese stelsel te simuleer en die funksionering daarvan te illustreer met betrekking tot hitte-oordrag. Dit is gedoen deur die ontwerp van 'n eksperimentele meganiese long apparaat. Die apparaat is getoets en slaag daarin om die respiratoriese stelsel suksesvol na te boots met betrekking tot hitteoordrag. Die resultate verkry uit hierdie eksperiment het aangedui dat die tragea kostant klam gemaak moet word om ingeasemde lug te kondisioneer. Die uitkoms van hierdie projek het twee moontlike toepassings geïdentifiseer. Die eerste is dat dit as 'n toets instrument vir die vinnige evaluering van die invloed van verskillende omgewingsfaktore in die temperatuur verspreiding van pasgebore babas gebruik kan word. Die tweede toepassing sal wees om medici in staat te stel om die invloed van die termiese omgewing te monitor, insluitend die temperatuur, relatiewe humiditeit en lug snelheid, om die neonaat se temperatuur verandering te monitor en voorsiening te maak vir 'n vinniger verwarmings intervensiestrategie.

published_or_final_version / Social Work / Master / Master of Social Work

The present study was undertaken to explore the relationship of cellular immunity to total serum ICE in an unselected sample of 278 healthy infants. Statistical analyses of infant history profiles and cellular immune and serum IgE determinations from cord blood and 10 month samples were performed using SPSSx. During the first year of life, the percent CD3, CD4, CD8, ERFC, and B-cell counts significantly increased and the CD4/CD8 ratio and responses to ConA and PW mitogens significantly decreased. Boys had lower percent CD8 cell counts and decreased responses to ConA and PW mitogens in cord blood. Cellular immune variable values were not associated with total serum ICE in any analysis. Early feeding method had no effect on 10 month serum IgE levels or cellular immune variables. Cord blood percent CD3 and CD4 cell counts were significantly decreased in infants with parental histories of asthma. In summary, (1) boys had a lower percent of suppressor T-cells and lower mitogen responses in cord blood (2) boys and girls reached similar levels for all variables by 10 months of age (3) infants with familial histories of asthma had fewer total and helper T-cells in cord blood.

A research thesis submitted for the degree of Doctor of Philosophy in Audiology in the Faculty of Humanities the University of the Witwatersrand March 2016. / Purpose: The main objective of the current study was to explore risk-based new-born hearing screening within a developing country by conducting early hearing detection in high-risk neonates within an academic hospital complex in Gauteng, South Africa. Specific objectives describing the case history factors and audio logical function in a group of high-risk determining the relationship between the case history factors and audio logical establishing the true-positive (TP) and true-negative (TN) results with different combinations of screening measures; establishing the percentage of TP and NT screening results in the total sample; and exploring the factors associated with follow-up return rate for hearing screening and diagnostic audio logical assessment. / GR2017

Orientador: Norma Sueli Pinheiro Módolo / Resumo: Objetivo: Sabendo-se que as experiências dolorosas pelas quais o recém-nascido é submetido podem ter relação com reações futuras e que existem diferenças no comportamento de resposta à dor nos recém-nascidos (RNs) oriundos de diferentes vias de parto, o estudo teve como objetivo avaliar a resposta à dor em bebês nascidos por cesariana e parto vaginal. Método: Trata-se de uma Coorte prospectiva, realizada na cidade de São Carlos/ SP. Participaram RNs nascidos a termo, divididos em dois grupos: cesariana (RPC) e parto vaginal (RPV). Utilizou-se, como estímulo doloroso agudo, injeção intramuscular rotineira ao nascimento, a vitamina K. Os RNs foram avaliados quanto à dor em duas escalas, sendo uma unidimensional, a Neonatal Facial Coding System (NFCS) e outra multidimensional, a COMFORT Behaviour Scale (Comfort b), além de contagem de frequência cardíaca, nos momentos antes, imediatamente após e 10 minutos após o estímulo. Foi utilizado Teste t de student para as análises, com significância de 5%. Resultados: Foram avaliadas 83 crianças. As escalas Comfort b e NFCS mostraram média maior no grupo RPC antes da ocorrência do estímulo doloroso, mas tal diferença não se demonstrou significativa estatisticamente. Em relação à frequência cardíaca, os valores encontrados tardiamente ao estímulo mostraram diferença significativa (p<0,05), sendo os valores do grupo RPC maiores que de RPV. Conclusões: Os dados obtidos não sugerem que existam diferenças na percepção da dor entre RNs nascido... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: It is already known that the painful experiences to which the newborn is subjected may be related to future reactions and differences in the behavior response to pain in newborns (NBs) from different birth routes. This study aimed to evaluate the response to pain in infants born by caesarean section and vaginal delivery routes. Method: This is a prospective cohort study performed in the city of São Carlos / SP. NBs born at full term were allocated into two groups: cesarean section (RPC) and vaginal delivery (RPV). The vitamin K intramuscular was performed as an acute pain stimulus because it is a routine injection at birth. The NBs were evaluated for pain on two scales, an one-dimensional, the Neonatal Facial Coding System (NFCS) and other multidimensional, the COMFORT Behaviour Scale (Comfort b), in addition to heart rate counting, moments before, immediately after and 10 minutes after the stimuli. Student's T-Test was used for statistical analyzes and the level of significance was 5%. Results: Eighty-three children were evaluated. In the first phase, the Comfort b and NFCS scales showed a higher mean in the RPC group at the moment before the pain stimulus, but this difference was not statistically demonstrated. But the values of heart rate after the stimulus was of significant difference (p<0,05), being higher RPC group than in the RPV. Conclusions: The results don’t suggest that there are differences in the perception of pain among NBs born vaginally and cesarea... (Complete abstract click electronic access below) / Doutor